dr. phil and psychology today as self-help treatments of...
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Dr. Phil and Psychology Today as Self-Help Treatments of Mental Illness: AContent Analysis of Popular PsychologyProgrammingEric Rasmussen a & David R. Ewoldsen aa School of Communication , The Ohio State University , Columbus ,Ohio , USAPublished online: 12 Feb 2013.
To cite this article: Eric Rasmussen & David R. Ewoldsen (2013) Dr. Phil and PsychologyToday as Self-Help Treatments of Mental Illness: A Content Analysis of Popular PsychologyProgramming, Journal of Health Communication: International Perspectives, 18:5, 610-623, DOI:10.1080/10810730.2012.743630
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Journal of Health Communication, 18:610–623, 2013Copyright © Taylor & Francis Group, LLCISSN: 1081-0730 print/1087-0415 onlineDOI: 10.1080/10810730.2012.743630
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Dr. Phil and Psychology Today as Self-Help Treatments of Mental Illness: A Content Analysis
of Popular Psychology Programming
ERIC RASMUSSEN AND DAVID R. EWOLDSEN
School of Communication, The Ohio State University, Columbus, Ohio, USA
Many people with a diagnosable mental illness do not receive professional treat-ment. Instead, they may turn to media mental health professionals for diagnosis and treatment recommendations. This study content analyzed episodes of Dr. Phil and issues of Psychology Today to determine what mental disorders are covered and treatments are recommended, and to determine whether their coverage of mental disorders corresponds to the national prevalence of mental disorders. Both sources provide content about depression more than about any other mental illness. Both also make recommendations for psychotherapy more than they recommend other forms of treatment. The study also found no relation between the proportion of times that mental disorders were discussed and the prevalence of the disorders among American adults. This research helps to lay a foundation for future research addressing the relations among mental disorders, self-treatment, and the media’s role in mental health.
More than 60 million adults suffer from a diagnosable mental disorder every year in the United States. It is striking that fewer than half of these people obtain professional treatment for their illness due to financial reasons, a stigmatized perception of the mentally ill, negative fictional media portrayals of psychologists, or for other reasons (Cole & Glass, 2005; Vogel, Gentile, & Kaplan, 2008), and are left on their own to manage their disorder.
While bibliotherapy, cinematherapy, and educational TV therapy treatment pro-grams successfully use tested strategies designed to treat mental disorders or their related symptoms (Marsick, 2010; McKendree-Smith, Floyd, & Scogin, 2003; van Straten, Cuijpers, Smit, Spermon, & Verbeek, 2009), evidence suggests that some people think television can be helpful in identifying and treating mental illnesses in themselves or in other people (Nguyen, Wittink, Murray, & Barg, 2008). If people perceive that mass media outlets can be a valuable source of information about mental disorders, it is important to investigate the content of popular media sources of psy-chology to determine whether the content they provide can be considered as anything more than just “infotainment.”
The purpose of this study was to content-analyze two widely used sources of psychology-specific information in popular media (episodes of Dr. Phil and articles in Psychology Today) to determine the type of information they provide relative to
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Media Psychologists and Mental Illness 611
the most prevalent mental disorders and treatments in the United States. These two outlets were chosen because of their dominance in the popular media that focuses on mental health issues. This research helps to lay a foundation for future research addressing the relationship between mental disorders, self-treatment, and the media’s role in mental health.
Mental Illness in America
Mental disorders such as depression and panic disorder are among the 17 leading causes of disability worldwide—depression, in particular, ranks third worldwide (WHO, 2008). Every year in the United States, 26.2% of adults suffer from a diagnos-able mental disorder (Kessler, Chiu, Dernier, Merikangas, & Walters, 2005), or about 60.2 million people in 2008 (U.S. Census Bureau, 2008). Fewer than half of these people (41.1%) received some sort of professional treatment for their disorder in the previous year (Cole & Glass, 2005).
It is expected that 24.8% of Americans will suffer from an impulse-control disor-der, such as pathological gambling, at some point during their life, followed by depres-sion (16.6%), Alzheimer’s (10–20%), a substance-related disorder (14.6%), and specific phobias (12.5%) (Alzheimer’s Association, 2010; Kessler et al., 2005). Among what are considered common disorders, Americans are least likely to suffer from schizophrenia (0.87%), agoraphobia (1.4%), autism (1.0%), obsessive-compulsive disorder (1.6%) and dysthymic disorder (chronic depression, 2.5%) at some point during their lives (Alzheimer’s Association, 2010; Centers for Disease Control and Prevention, 2009; Kessler et al., 2005).
Diagnosis and Mediated Treatment of Mental Illness
In the United States, mental illnesses are diagnosed using the Diagnostic and Statistical Manual on Mental Disorders (4th edition; American Psychiatric Association, 1994). This study’s content analysis was based on the most common mental illnesses (National Institute of Mental Health, 2010; see Table 1). Common forms of treatment of mental illnesses include psychotherapy, pharmacological (medication) therapy (National Insti-tute of Mental Health, 2000), or a combination of both (March et al., 2004).
A large portion of the working and family-rearing population suffering from mental illness in America is untreated by professionals. Cole and Glass (2005) argued that mentally ill people may not seek treatment for their disorder because of financial reasons, lack of access to health care, structural reasons such as the lack of mental health programs and practitioners, or for personal reasons such as concerns about confidentiality or discrimination. They may also avoid professional treatment because of dramatic, comedic, or negative fictional television portrayals of psychologists (Vogel et al., 2008); the expectation by the individual that others will stigmatize them on the basis of negative portrayals of the mentally ill (Corrigan, 1998, 2004); or, on the basis of the assumption that health beliefs are determinants of help-seeking behavior (Edlund et al., 2008), t hey underestimate the effectiveness of professional mental health treatment programs, or may even consider profes-sional treatment as more harmful to those suffering from mental illness than non-professional treatment, such as relaxation, exercise, yoga, or turning to one’s family for support (Goldney, Fisher, & Wilson, 2001; Highet, Hickie, & Davenport, 2002; Jorm et al., 1997).
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612 E. Rasmussen and D. R. Ewoldsen
Media Outlets for Mental Health Treatment
Bibliotherapy, or reading books specifically designed for self-administered treatment, has been shown to be an effective form of therapy in cases of absence of or minimal interaction with a therapist (Apodaca & Miller, 2003; Den Boer, Wiersma, & Van den Bosch, 2004; Evans et al., 1999; Floyd & Scogin, 1998; Ghaderi & Scott, 2003; Lovell, Ekers, Fulford, Baguley, & Bradshaw, 2004; McKendree-Smith et al., 2003; Morin, Mineault, & Gagne, 1999; Tate & Zabinski, 2004). The benefits of bibliotherapy have been attributed to its ability to increase perceived self-efficacy in caring for oneself as a result of increased knowledge and skills development (McKenna, Hevey, & Martin, 2010). Cinematherapy is an extension of bibliotherapy in which films relevant to the patient’s mental health issues are watched (Marsick, 2010). Marsick (2010) and Aka and Gencoz (2010) showed that cinematherapy improved a multitude of symptoms related to quality of life. These results speak to the ability of book and screen-medi-ated self-therapy to improve one’s ability to cope with problems related to their mental health through increased education.
Despite the strategic nature of these mediated self-help programs, some study par-ticipants have spontaneously suggested that television can be helpful in identifying and treating mental illnesses such as depression (Nguyen et al., 2008); however, past research related to mass on-air treatment by media psychologists suggests that people who suffer from mild forms of easily treatable diseases may delay treatment or develop more serious problems after hearing on-air treatment advice given to someone else (Klonoff, 1983). Therefore, investigation of the content of popular media sources of psychology to determine whether the content they provide can be considered as any-thing more than just entertainment, or infotainment, is warranted. Two such media sources are Dr. Phil and Psychology Today.
Dr. Phil and Psychology Today
Dr. Phil and Psychology Today are the two most widely distributed popular media sources of information about psychology. While Dr. Phil, the person, uses television, books, and other media to address relationships and better living, Dr. Phil the show is marketed as providing “the most comprehensive forum on mental health issues in the history of television” and a “platform to make psychology accessible and understand-able to the general public” (Dr. Phil, 2011). Psychology Today, formerly published by the American Psychological Association, claims to cover all aspects of mental health (Psychology Today, 2011).
The Dr. Phil show has had ratings second only to Oprah Winfrey among talk shows, is among the top 25 syndicated programs for the 18–49-year-old segment, and is still gaining viewership (Jones, 2008; Tanklefsky, 2010). As of 2008, Dr. Phil was seen on more than 200 television stations, collectively representing about 99% of the national viewing public (Henson & Parameswaran, 2008). Scholars have called Dr. Phil the “nation’s leading celebrity psychologist” (Henson, 2008, p. 288), and the Dr. Phil show averages nearly seven million viewers each day, many of whom are adult females ages 25–54 years (Henson, 2008; Martinez, Zimmerman, Matheson, & Banning, 2011; Ventura, 2005). Although Dr. Phil, a clinical psychologist and self-billed as “perhaps the most well-known mental health professional in the world” (Dr. Phil, 2011), does not represent all psychologists on television, his reach among celebrity psychologists appears to be the greatest.
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Media Psychologists and Mental Illness 613
In addition to popular television psychologists such as Dr. Phil, a popular maga-zine devoted to psychology issues, Psychology Today, can be found in doctors’ offices, school libraries, supermarkets, retail stories, health food stores, pharmacies, and book and music stores across the country. Although its reach is not as large as Dr. Phil’s, Psychology Today still claims a readership of more than 3.5 million, and its audience’s demographic is similar to that of Dr. Phil, with 18–54-year-old women dominating the readership. In addition, the Psychology Today website reports approximately 6.5 mil-lion total page views per month (Psychology Today, 2010).
Because of his reach, several studies have examined the effectiveness of Dr. Phil’s helpfulness in various life domains, with varying results—some suggest his advice empowers individuals (Robinson, 2004), while others concluded that his advice is potentially detrimental to marriage and family relationships (Martinez et al., 2011; Winslow, 2005), and is less therapeutic than it is do-it-yourself (Nussey, 2005). Some researchers are concerned that the mingling of therapy with self-help advice in popular media, such as Dr. Phil and Psychology Today, may cause those suffering from mental illness to attempt to manage their disorder by following the advice of media psycholo-gists (Broder, 1983), rather than receiving personalized, professional treatment.
While the literature suggests that the media may be a channel through which psychologists can help improve the social and emotional functioning of individuals (Klonoff, 1983), studies have yet to show positive effects of exposure to media psy-chologists. There is a lack of research on popular psychology programming’s effects on those suffering from mental illness. One of the aims of this study is to identify what is being said about mental illness by popular media psychologists in order to guide future research into the effects of such content. Just as media coverage of some dis-eases motivates healthy people to self-diagnose and demand treatment (Moynihan & Henry, 2006), mental health topics that are made salient through media coverage could lead audience members to self-diagnose or doctors to overdiagnose salient disorders. Recent research indicates that this may be the case for attention deficit hyperactivity disorder and bipolar disorder, among others (Dyer, 2006). Therefore, to understand how mental disorders are covered by the popular media psychology outlets of Dr. Phil and Psychology Today, and to guide future research into the effects of exposure to such content, we posed the following research question:
Research Question 1: What are the most common mental illnesses addressed by Dr. Phil and Psychology Today?
If Dr. Phil and Psychology Today function as self-diagnosis tools for some viewers, it would be desirable for these diagnoses to be similar to the national prevalence of the illnesses, or similar to the proportion of people with a mental illness who actually seek treatment for their disorder. A first step at evaluating the effectiveness of these outlets is to determine whether they cover topics specifically tailored to the mentally ill who are seeking treatment via media channels. As mentioned previously, less than half of Americans with a mental disorder receive treatment for their disorder, while 64.5% of those who suffered from a major depressive episode in the last year sought treatment (Substance Abuse and Mental Health Services Administration, 2008). It is unclear in the literature why it appears Americans are more willing to seek treatment for depres-sion than for other mental disorders—thus, we are left to assume that the rate of treatment-seeking activities for mental disorders besides depression is equal across the range of common disorders. We argue, however, that absent comparable treatment
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614 E. Rasmussen and D. R. Ewoldsen
statistics by disorder, that media outlets are covering topics specifically tailored to the mentally ill population if the proportion of time spent on particular mental disorders matches the actual prevalence of the disorders.
Therefore, we posed the following research question:
Research Question 2: Does a relation exist between the most prevalent mental illnesses in America and the mental illnesses addressed by Dr. Phil and Psychology Today?
Once the coverage of specific mental disorders by Dr. Phil and Psychology Today has been analyzed, the next step towards understanding the potential therapeutic value of the sources is to identify the treatments they recommended most. If Dr. Phil and Psychology Today are to be considered sources of self-help treatment, the treat-ment recommendations provided therein must first be analyzed. Therefore, we posed the following research question:
Research Question 3: What are the most common treatment recommenda-tions by Dr. Phil and Psychology Today?
Method
Sample
The sample was obtained from episodes of Dr. Phil and issues of Psychology Today. While both sources provide content on other topics seemingly unrelated to mental health, a large portion of their content, as will be shown below, is devoted to mental health issues. The sample from Dr. Phil consisted of randomly selected episodes from 2008 and 2009 (n = 60). A 6-week continuous period was randomly selected from each calendar year, totaling 30 episodes per year. The transcript of each episode was purchased from Burrelle’s Information Services, the company enlisted by Dr. Phil to control the public’s use of show transcripts. The Psychology Today sample consisted of every article listed as a main article in every issue of Psychology Today in 2008 and 2009 (n = 50). The articles were obtained from the archives link at www.psychologytoday.com, and main articles were identified as all feature articles listed above “More From This Issue” on each issue’s archive page, and tended to be nonrecurring sections of the periodical. Lacy, Robinson, and Riffe (1995) found that one randomly selected issue per month of a weekly publi-cation can efficiently predict a year’s worth of content. Because Psychology Today is a monthly publication, a census of a 2-year time period was analyzed.
Content Analysis Coding
Four coders, including one of the researchers and three research assistants, were trained to code Dr. Phil transcripts and Psychology Today articles. The group met weekly over a period of several months to discuss the units and the coding categories, identify representative examples of each of the categories, practice the coding, and discuss instances of disagreement on the practice examples.
Diagnosis Reported or Given Coded identifiable mental illnesses were those mental illnesses listed by the National Institute of Mental Health (2010) as statistically prevalent among the U.S. populace
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Media Psychologists and Mental Illness 615
and consistent with the name of the diagnosis in Diagnostic and Statistical Manual on Mental Disorders (4th edition). During coder training, coders read sample transcripts of Dr. Phil episodes and sample articles from Psychology Today and identified addi-tional consistently recurring mentions of mental illnesses beyond those enumerated by the National Institute of Mental Health (2010)—these were also coded in order to capture what the public perceives as a highly prevalent mental illness. The standard unit of analysis for this variable was a single Dr. Phil episode or a single Psychology Today article. Each individual mention of a term from the coding scheme in each episode or article was identified—if a mention of a term from the coding scheme appeared in an episode or article, the episode or article was coded as containing that term; however, multiple mentions within a single article or episode were documented, as some analyses required identification of each individual mention. The following 21 categories were included in the coding scheme: Autism, attention deficit hyperactiv-ity disorder, Alzheimer’s, substance-related disorders, schizophrenia, major depressive disorder, dysthymic disorder, bipolar disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, social phobia, agoraphobia, specific phobias, eating disorders, sexual and gender identity disorders, sleep disorders, impulse-control disorders, other/less common disorders (disorders not mentioned as prevalent by the National Institute of Mental Health, 2010), and mention of mental disorders in general (reference to mental disorders in general, rather than to a specific mental disorder). Intercoder reliability was calculated using Krippendorf’s alpha (Hayes & Krippendorff, 2007) and coding was completed after obtaining reliability using 10% of the Dr. Phil sample’s episodes (α = .91), and for 10% of the Psychology Today articles (α = .89).
Treatment Recommendation Each mention of a treatment recommendation related to a specific mental disorder was coded into one of four categories: psychotherapy, pharmacotherapy/medication, on-show advice/self-help, and medical doctor. Psychotherapy included all forms of therapy where talking about one’s condition or other nonmedication therapy was mentioned as treatment for a specific disorder. Pharmacotherapy/medication included mentions of psychiatry or other medicinal therapies for a specific mental disorder. On-show advice included tips or advice related to a specific mental disorder. Last, any mention of a family practitioner or general physician as a source of treatment for a specific mental disorder was coded in the medical doctor category. Intercoder reli-ability was calculated using Krippendorf’s alpha (Hayes & Krippendorff, 2007) and coding was completed after obtaining reliability for Dr. Phil using 10% of the Dr. Phil sample’s episodes (α = 1.0), and for 10% of the Psychology Today articles (α = 1.0).
Results
The first research question asked what the most common mental illnesses addressed by Dr. Phil and Psychology Today were. Diagnoses of a specific mental illness were mentioned in 50% of Dr. Phil episodes and in 56% of Psychology Today articles. The most mentioned disorder in Dr. Phil and Psychology Today was major depressive dis-order (see Table 1). The disorder was mentioned in 23.3% of Dr. Phil episodes and 26.7% of Psychology Today articles. Nationally, 6.7% of U.S. adults suffer from major depressive disorder each year (National Institute of Mental Health, 2010). However, the lifetime incidence of major depressive disorder is close to 25% of women and up
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616
Tab
le 1
. C
omm
on m
enta
l dis
orde
rs a
nd t
hose
men
tion
ed b
y D
r. P
hil a
nd P
sych
olog
y T
oday
Men
tal d
isor
der
Ann
ual %
Lif
etim
e %
Ran
k
Dr.
Phi
lP
sych
olog
y T
oday
%R
ank
%R
ank
Aut
ism
N/A
1.0c
163.
36
3.3
5A
tten
tion
def
icit
hyp
erac
tivi
ty d
isor
der
4.1a
8.1b
83.
36
3.3
5A
lzhe
imer
’sN
/A10
–20d
40.
09
0.0
7Su
bsta
nce
13.4
e14
.6b
513
.33
3.3
5Sc
hizo
phre
nia
1.1a
0.87
d18
5.0
51.
76
Dep
ress
ion
6.7a
16.6
b3
23.3
126
.71
Dys
thym
ic1.
5a2.
5b14
0.0
90.
07
Bip
olar
2.6a
3.9b
132.
67
1.7
6P
anic
2.7a
4.7b
110.
09
1.7
6O
bses
sive
-com
puls
ive
diso
rder
1.0a
1.6b
158.
34
3.3
5P
ostt
raum
atic
str
ess
diso
rder
3.5a
6.8b
91.
78
5.0
4A
nxie
ty3.
1a5.
7b10
8.3
410
.02
Soci
al p
hobi
a6.
8a12
.1b
73.
36
1.7
6A
gora
phob
ia0.
8a1.
1b17
0.0
90.
07
Spec
ific
pho
bias
8.7a
12.5
b6
3.3
61.
76
Eat
ing
diso
rder
sN
/A4.
4b12
5.0
56.
73
Gen
der
IDN
/AN
/AN
/A1.
78
0.0
7Sl
eep
35–4
0fN
/AN
/A0.
09
3.3
5Im
puls
e-co
ntro
l10
.5e
24.8
b2
5.0
50.
07
Oth
erN
/AN
/AN
/A5.
05
0.0
7G
ener
al32
.4e
46.4
b1
18.3
21.
76
a Nat
iona
l Ins
titu
te o
f M
enta
l Hea
lth
(201
0).
b Kes
sler
, Chi
u, e
t al
. (20
05).
c C
ente
rs f
or D
isea
se C
ontr
ol a
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reve
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009)
. d A
lzhe
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’s A
ssoc
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2010
).
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, Ber
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t al
. (20
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f H
ossa
in &
Sha
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(20
02).
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Media Psychologists and Mental Illness 617
to 12% of men (American Psychiatric Association, 1994). The second most mentioned diagnosis in both outlets was generalized anxiety disorder—8.3% of Dr. Phil episodes and 10% of Psychology Today articles included a reference to generalized anxiety, compared with the national average prevalence of the disorder of 3.1%, and the life-time prevalence of 5.7%.
Other mental disorders were overrepresented by the media psychologists (see Table 1). Both outlets overrepresented the incidence of schizophrenia: approximately .87% of the population suffers from schizophrenia, but 5% of Dr. Phil’s episodes and 1.7% of Psychology Today articles mentioned schizophrenia. In addition, both outlets overrepresented obsessive-compulsive disorder (8.3% of Dr. Phil episodes and 3.3% of Psychology Today articles, compared with 1.6% of the population). Psychology Today also overrepresented the lifetime prevalence of eating disorders (6.7% of all articles compared with 4.4% of the population).
The outlets, in turn, underrepresented several mental disorders. Both underrep-resented attention deficit hyperactivity disorder, dysthymic disorder, bipolar disorder, panic disorder, posttraumatic stress disorder, social phobias, and specific phobias. Psychology Today also underrepresented the lifetime prevalence of agoraphobia (see Table 1).
The second research question asked whether or not a relationship existed between the most prevalent mental illnesses in America and the mental illnesses addressed by Dr. Phil and Psychology Today? Because of the ordinal nature of these data, and because the data are categorized using different metrics, this study used a Spearman’s rank-order correlations analysis (Siegel & Castellan, 1988). The analysis revealed no significant association between the mental disorders prevalent across the lifetime of people in the United States and those covered most frequently by media psychologists on Dr. Phil (rs(19) = .365, p = .137) and in Psychology Today (rs(19) = .023, p = .927). It is interesting that a post hoc Spearman’s rank-order correlations analysis revealed a moderate positive association between the mental disorders most mentioned by both sources (rs(19) = .458, p = .037), suggesting that there is a fair degree of overlap in the disorders mentioned by both outlets.
Research Question 3 asked what the most common treatment recommendations by Dr. Phil and Psychology Today were. Most common treatment recommendations refers to the total number of mentions of each treatment across all episodes, not to the number of episodes containing the treatment mention. A chi-square test of good-ness-of-fit was performed to determine whether the four mental illness treatment rec-ommendations (psychotherapy, pharmacotherapy, referalls to a medical doctor, and on-show advice) were equally mentioned in both outlets. Mentions of each of the four treatments in both outlets were not equally distributed in the combined sample, χ²(4) = 3.57, p < .05. Dr. Phil episodes contained 59 instances of treatment recommen-dation that included a referral to psychotherapy for the treatment of a specific mental illness, compared with 36 instances of on-show advice for dealing with a specific men-tal illness, six instances of a referral to a medical doctor and five instances of a referral to pharmacotherapy. In terms of the percentage of episodes containing each recom-mendation, 16.67% of Dr. Phil episodes contained references to psychotherapy recom-mendations, 8.33% contained on-show advice, 6.67% contained references to medical doctor referrals, and 5% contained instances of pharmacotherapy recommendations. Psychology Today contained more instances of referall to psychotherapy (30) than in-article advice (27), pharmacotherapy (23), and referalls to a medical doctor (10). From a different perspective, however, the percentage of articles containing instances
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618 E. Rasmussen and D. R. Ewoldsen
of referrals for specific treatment resulted as follows: medical doctors (20%), pyscho-therapy (10%), in-article advice (10%), and pharmacotherapy (8%). A chi-square test of goodness-of-fit was performed to determine whether the four mental illness treat-ment recommendations were equally mentioned in Dr. Phil and Psychology Today. Mentions of each of the four treatments in both outlets were not equally distributed in the combined sample, χ²(4) = 3.57, p < .05.
Discussion
A majority of the Americans suffering from a mental disorder go untreated by profes-sionals, and instead resort to self-help coping methods. As media psychologists have gained popularity, it is worthwhile to investigate whether the most popular media psy-chology sources address topics salient to these undiagnosed millions. This research lays the groundwork for future research to determine what might be potential predic-tors and effects of media psychology programming. To that end, this study identified what mental illnesses are contained in the content of two popular sources of media psychology, how those mental illnesses are presented in relation to the actual national prevalence of those disorders, and treatment recommendations contained in the popu-lar psychology programming content.
The content analysis of Dr. Phil and Psychology Today revealed that the coverage of mental disorders by these popular sources of media psychology is addressed dispro-portionately to the actual prevalence of the disorders among the American popula-tion—the analysis found no relation between the proportion of times mental disorders were discussed and the prevalence of the disorders among American adults. Further-more, about half of all episodes of Dr. Phil and articles in Psychology Today are silent on the topic of mental disorders.
One danger of disproportionate coverage of mental disorders lies in the coverage’s potential to lead some healthy people to believe they are mentally ill (Moynihan & Henry, 2006) and to leave some who are mentally ill without the information they are seeking related to their specific illness. While research is needed to see whether these effects actually occur, previous research suggests that it is a clear possibility (Dyer, 2006). In contrast, it is also possible that disproportionate coverage of mental illnesses may actually help people suffering from a mental disorder hear or learn about men-tal illnesses of which they had been previously unaware, leading to a self-diagnosis and to treatment-seeking behaviors which may not occurred had the coverage been proportionate. This is possible whether the disproportionate coverage is intentional due to the desire to cover a wide range of illnesses so as to reach as many members of the audience as possible, or simply due to the programming’s need to present mental disorders with relatively easy treatment options for the sake of the psychologist or of the audience. This study critically lays the foundation for future research to investigate the effects of disproportionate coverage.
Dr. Phil and Psychology Today, however, may be considered consistent sources of information on depression. It appears that on an annual basis, major depressive disorder is consistently and disproportionately represented by Dr. Phil and Psychology Today compared to the national prevalence of the illness, though on a lifetime risk basis, their coverage of depression is in line with the national prevalence of the disor-der, at least for women. It is likely that in a given week of watching Dr. Phil, or within an issue of Psychology Today, audience members will find information regarding the diagnosis of depression. It is possible that depression is a topic of interest for content
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producers due to the influence of pharmaceutical advertisers on editorial calendars (Balasubramanian, Karrh, & Patwardhan, 2006; Lesly, 1991; Singer, 1991; Soontae & Bergen, 2007). In contrast, perhaps the level of depression coverage by these two outlets helps those with depression. It is also possible that such consistent coverage of depression leads people to believe they are depressed and to seek help where none is needed. It is also conceivable that people with depression will seek to cope with the illness solely on the advice and anecdotes presented by Dr. Phil and Psychology Today. Whether these effects occur is uncertain. Future research should study the potential reasons for and effects of the pervasive coverage of depression, and other dispropor-tionately overrepresented mental illnesses, by Dr. Phil and Psychology Today.
In contrast, less common disorders such as autism and schizophrenia are overrep-resented and other more common disorders are underrepresented. Again, the effects of such over- and under-representation should be examined in the future, specifically relative to their effect on seeking-out professional treatment and the effectiveness of following the mediated advice of Dr. Phil and Psychology Today. Future research should also examine the reasons for and effects of the relationship between the mental disorders mentioned by the two sources.
Further research is also needed to determine whether the referrals to psycho-therapy for treatment by the two outlets influence audience members to seek psycho-therapy. We would expect that psychotherapists would seek to reinforce their role in society with access to such mass outlets. Psychotherapy was the most common treat-ment recommendation (number of total mentions, regardless of how many episodes in which it was mentioned) for dealing with a specific mental illness by both Dr. Phil and Psychology Today. On-show advice was the second most common treatment recom-mendation. Recommendations for treatment of a mental illness to other health profes-sionals greatly outnumbered the amount of on-show or in-article advice. Thus, instead of receiving practical treatment advice, many members of the audiences of these two sources are advised to seek professional help. Such recommendations could leave those viewers who have not sought treatment in the situation where whatever obstacle pre-venting them from seeking professional, individualized treatment in the first place remains. It is also possible that relatively little on-show advice is given because pro-ducers may want to avoid liability should a viewer try the treatment and fail, or to avoid on-air advice in order to adhere to the American Psychiatric Association’s ethi-cal guidelines that individual diagnosis and therapy belong in a private professional context (Pryzwansky & Wendt, 1987).
Future research is also needed to determine the prevalence and results of the effects of treatment advice, or lack thereof, from Dr. Phil and Psychology Today, especially rela-tive to the extensive coverage of depression by both outlets. It is possible that depression and the treatments found to be associated with it (psychotherapy and medication) are so prevalent because the clinical psychologists in these mediums use the platform as a way to recruit clientele to the profession they represent. It is also conceivable that depression and drug treatment for depression account for much of the content because of the prof-itability of those drugs, assuming there is in fact a relationship between advertisers and the gatekeepers of these two outlets. Further investigation into these and similar predic-tors of the content of popular psychology programming is warranted.
The results also raise the question of why some mental illnesses are salient to the programming of Dr. Phil and Psychology Today while others are seemingly avoided. We would offer one potential reason for the disconnect. In agreement with Pryzwan-sky and Wendt (1987) we suggest that some forms of mental illness, such as autism
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and eating disorders, are more media friendly, and it may be difficult for media psy-chologists to avoid the sensationalism associated with the drive for ratings to which the media are prone. Klonoff (1983) suggested that the media are often interested in issues that are “particularly extraordinary, widespread, or sudden” (p. 850). The results of this study suggest that this may be the case, though further investigation is warranted.
Limitations and Suggestions for Future Research
As far as we know, this study is the first to content analyze media psychology pro-gramming relative to the issue salience of mental disorders. This study evaluated only Dr. Phil and Psychology Today, and did not evaluate other popular sources of media psychology content, such as popular bibliotherapy or cinematherapy media, psychol-ogy-related radio programming, or Internet sites devoted to mental health topics. Future work should investigate, through theoretical frameworks, the issue salience of mental disorders in other popular mediums for psychology programming.
This study provides evidence that the coverage of mental disorders by Dr. Phil and Psychology Today is not proportionate to the prevalence of those mental dis-orders among the American population. This discrepancy begs two questions. First, what are the effects of such content on audience members? Second, what are the pos-sible reasons for this disproportionate coverage? Future research should investigate explanations for and effects of the apparent disconnect between the public’s needs and these media psychologists’ offerings. It is possible that the mental disorders of some audience members are exacerbated, or at least prolonged, by the inability of media psychologists to meet treatment needs. It is possible that psychologists and the subject of attention act differently on television than they would in a personalized profes-sional setting (Xiaoping, 2008). It is also possible that some audience members benefit from the variety of information presented. In addition, it is possible that the salience of media topics is transferred to the audience, resulting in audience members’ belief that they suffer from mental disorders that they do not have. It is also logical to suggest that a print source and a broadcast source of mental health information have differ-ent effects on the basis of how each is cognitively processed. For example, a broadcast source such as Dr. Phil may add a greater affective component which could lead to different effects than a source without such an affective component.
From a media systems perspective, it is possible that certain aspects of media production, such as agenda setting, influence the disproportionate coverage of men-tal illnesses. Future research should identify specific predictors and effects of, and motivations for, seeking out the content offerings of Dr. Phil, Psychology Today and other media psychology outlets. Such investigations would provide the mentally ill with knowledge about the context surrounding the content and possible outcomes of attending to the content, whether that context is an altruistic motive to help (Gold-berg, 2006) or simply to provide entertainment, should they turn to these media psychologists for help in dealing with mental illness.
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